GI articles 2021-11-17 - 2021-12-02
| This issue includes 221 articles. Hope you enjoy reading and benefit from our work! |
Guidelines
| Am J Gastroenterol |
ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided. |
| Gut |
Objective prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas. |
Meta-analysis
meta-analyses and systematic reviews
| Aliment Pharmacol Ther |
Numerous environmental and dietary factors influenced the development of IBD in both Western and Eastern populations, whereas certain factors influenced IBD risk differently in these populations. |
HBsAg loss is associated with a reduced risk of clinical outcomes. However, several shortcomings in the published studies prevent a more definitive conclusion on the potential benefits of HBsAg loss. |
There are no validated clinical, endoscopic, or histologic outcomes to assess disease activity in ICIC. Development and validation of reliable and responsive outcome measures that can be used to measure disease activity will be paramount for both clinical practice and for the development of treatments. |
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
This study demonstrates that patients receiving LT for NASH cirrhosis have comparable complication rates, overall survival and graft survival compared to non-NASH patients although close monitoring may be indicated for those with higher MELD scores. |
Overall, despite high heterogeneity among studies, this meta-analysis demonstrated that higher caloric intake is positively associated with NAFLD, while diet composition in macronutrients was not associated with the presence or severity of disease. |
| Gastroenterology |
A sizable proportion of late-stage PDACs were detected during follow-up. Their incidence lacked association with baseline clinicoradiologic features. Further causal investigation of stage-based outcomes is warranted for overall improvement in HRI surveillance. |
| Gastrointest Endosc |
| Inflamm Bowel Dis |
Approximately 1 in 5 patients with CD develops perianal disease within 10 years of CD diagnosis, including 11.5% who have perianal disease at presentation. Approximately two-thirds of patients require perianal surgery, with a smaller fraction requiring major abdominal surgery. |
Our study demonstrated that AEs after vaccination are mainly local or mildly systemic and do not differ significantly from the expected AE after recommended immunizations for the general population. Thus, gastroenterologists should reinforce that vaccines are safe in patients with IBD. |
Limited high-quality evidence suggest that imaging characteristics may help discriminate CD from CGD in patients with perianal fistulas. Larger, prospective studies are needed to confirm these findings and to evaluate if combining multiple diagnostic tests can improve diagnostic sensitivity. |
Open access
Articles that are open access at time of publication, full text is typically available in PMC (link provided)
There are 3 open access articles in this group, that can be accessed through PMC as full text.
Moreover, many of the guidelines, editorials and case reports are also open access through the provided publisher link.
| Gastroenterology |
| J Hepatol |
Studies
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
Epstein-Barr virus status and immunosuppression use in paediatric autoimmune liver disease. Real-world data demonstrate that EBV serostatus is not routinely checked before immunosuppression for paediatric AILD. Lymphoproliferative disorder was not diagnosed in those with native livers; however, EBV IgG-negative LT recipients receiving EBV IgG-positive donor organs are at risk of early PTLD. Large multicentre studies with longer follow-up are required to further evaluate the risk. |
Concurrent fatty liver was associated with a higher risk of HCC and mortality in patients with chronic viral hepatitis. Our results suggest the importance of management of fatty liver to reduce the risks of HCC and mortality in patients with chronic viral hepatitis. |
Serum GDF15 predicts de novo HCC occurrence. Scoring using GDF15, AFP, and the FIB-4 index can predict de novo HCC occurrence risk after HCV elimination. |
| Am J Gastroenterol |
In this multicenter randomized trial, CSP is safe and effective with very low rates of incomplete resection independent of the diameter of the snare wire used. This suggests that the optimal operator technique is more important than the snare design alone in minimizing residual adenoma after CSP. |
Abstract The burden of diarrheal infections globally, including the chronic health consequences, is an important problem. Herein we describe a recent paper published by the Journal and describe how it fits within and advances our knowledge in this area. |
Almost al patients with IBD in our study mounted an antibody response. Future studies are needed in evaluating sustained humoral immunity and the impact of booster dosing in patients with IBD. |
Eradication and recurrence rates of Barrett's intestinal metaplasia and neoplasia by means of hybrid argon plasma coagulation at 2 years seem to be within expected ranges. Final evidence in comparison to radiofrequency ablation can only be provided by a randomized comparative trial. |
Increasing Incidence of Cirrhosis Over the Past 2 Decades Among Children in Ontario, Canada. In this first population-based study in children, the incidence of cirrhosis has increased dramatically over the past 2 decades. |
Symptoms do not reliably indicate gluten exposure in either subjects with CeD or NCGS. IL-2 production indicates a rapid-onset gluten-induced T-cell activation in CeD despite long-standing treatment. The effector site is unknown, given no increased intestinal permeability after gluten. |
Outcomes of IBD care were improved using a structured quality improvement program that facilitates small process changes, sharing of best practices, and ongoing feedback. Spread of these interventions may facilitate broad improvement in IBD care when applied to a large population. |
The EoE-HSS is highly responsive, performs similarly to PEC, and is better correlated with changes in overall histologic activity in patients with EoE. |
| Clin Gastroenterol Hepatol |
Gluten intake and risk of digestive system cancers in three large prospective cohort studies. Gluten intake was not associated with risk of digestive system cancers in adults without celiac disease. Restricting dietary gluten is unlikely to be beneficial to the prevention of digestive system cancers in the general population. |
Prevalence of Forceps Polypectomy of Non-Diminutive Polyps is Substantial but Modifiable. Inappropriate forceps polypectomy is common but modifiable. The proportion of non-diminutive polyps removed with forceps polypectomy should be considered as a quality measure. |
Achieving a sustained clinical remission off steroids with complete endoscopic remission in this cohort of 95 patients with early CD was not associated with less disease progression. Prospective trials to define the therapeutic goals that change the natural history of CD and prevent complications are needed. |
Symptom Classes are Independent of Disease Severity in Decompensated Liver Disease. Patient reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patients' history of ESLD complications may enhance providers' ability to improve symptom management for this population. |
| Endoscopy |
CAQ significantly improved the efficacy of CADe in a four-group parallel controlled study. No significant difference in the ADR or PDR was found between the CAQ and COMBO groups. |
Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH offering the advantages of lower early and late rebleeding rates, reduced need for IVR, and shorter LOS. |
| Gastroenterology |
Data suggest a previously unknown sequence of events culminating in intestinal barrier dysfunction upon G. duodenalis infection during which alterations of cellular ion transport were followed by breakdown of the tight junctional complex and loss of epithelial integrity, events involving a cAMP/PKA-CREB mechanism. These findings and the newly established organoid-derived model to study G. duodenalis infection may help to explore new options for intervening with disease and infection, in particular relevant for chronic cases of giardiasis. |
Rome Foundation Clinical Diagnostic Criteria for Disorders of Gut-Brain Interaction (DGBI). If this is the case, a lower frequency and a shorter duration (8 weeks or more) than those required for the Rome DGBI diagnostic threshold are allowed, provided that there is clinical confidence that other diagnoses have been sufficiently ruled out based on presentation and additional investigations as needed. Applying these criteria for clinical practice will allow the clinician to make a diagnosis, reduce unnecessary diagnostic studies and enhance the patient-provider relationship. Further research is needed to validate these recommendations. |
| Gut |
Footprints of a microbial toxin from the gut microbiome to mesencephalic mitochondria. Taken together, our results demonstrate that chronic exposure to dietary BMAA can trigger a chain of events that recapitulate the evolution of the PD pathology from the gut to the brain, which is consistent with 'gut-first' PD. |
We confirmed that microbiome colonisation is strongly affected by CS delivery. Our findings suggest that maternal antibiotic administration prior to CS does not result in a second hit on the compromised microbiome. Future, larger studies should confirm that antenatal antibiotic exposure in CS born infants does not aggravate colonisation impairment and impact long-term health. |
Survival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future. |
50% of IBS cases manifested a 'pathogenic' gut microbial signature. This shifted towards the healthy profile on the low FODMAP diet; and IBS P cases showed an enhanced clinical responsiveness to the dietary therapy. The effectiveness of FODMAP reduction in IBS P may result from the alterations in gut microbiota and metabolites produced. Microbiota signatures could be useful as biomarkers to guide IBS treatment; and investigating IBS P species and metabolic pathways might yield insights regarding IBS pathogenic mechanisms. |
| Hepatology |
Combination of LOLA with lactulose and rifaximin was more effective than only lactulose and rifaximin in improving grades of HE, recovery time from encephalopathy with lower 28-day mortality. |
The digital DBU case-finding algorithm efficiently identified potential HCV treatment candidates, freeing resources for navigation and coordination. The algorithm is portable and accelerated HCV elimination when incorporated in our comprehensive program. |
An ML model based on trichrome-stained liver biopsy slides can predict CSPH in patients with NASH with cirrhosis. |
| Inflamm Bowel Dis |
Our findings warrant particular attention to the anti-SARS-CoV-2 vaccination of IBD patients treated with TNF-α inhibitors with concomitant immunomodulators and show the priority of mRNA vaccines in this specific group of patients. |
Association Between Inflammatory Bowel Disease and Dementia: A Longitudinal Cohort Study. Our study does not support a significant association between IBD and dementia. Further studies with better design and longer follow-up are needed to elucidate the association. |
Inflammation is a driving factor both in inflammatory bowel disease and cancer, but the mechanism underlying the transition from colon inflammation to cancer remains to be defined. Dysregulation of mucosal glycosylation has been described as a key regulatory mechanism associated both with colon inflammation and colorectal cancer development. In this review, we discuss the major molecular mechanisms of colitis-associated cancer pathogenesis, highlighting the role of glycans expressed at gut epithelial cells, at lamina propria T cells, and in serum proteins in the regulation of intestinal inflammation and its progression to colon cancer, further discussing its potential clinical and therapeutic applications. |
Patients with UC, treated with 5-ASA, had no increased risk of hospitalization for coronavirus disease 2019 or more adverse in-hospital outcomes. In patients with CD, 5-ASA may be associated with an increased risk of hospitalization but not with more adverse in-hospital outcomes. |
Etrolizumab showed a dose-proportional increase in Cmax and a slightly greater than dose-proportional increase in AUCtau. Both regimens achieved complete/near-complete β7 receptor occupancy, with a similar relationship to concentration as adults. Etrolizumab was well tolerated and demonstrated clinical activity in children. |
In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure. |
| J Crohns Colitis |
SDL correlated with tissue free drug levels, however, different dynamics were observed for TNF-drug complex levels. Infliximab and adalimumab tissue drug dynamics differ. Better understanding of these interactions may allow future therapeutic optimization. |
Efficacy of pharmacological agents for ulcerative proctitis: a systematic literature review. The role of topical 5-ASA as treatment for ulcerative proctitis has been confirmed in this systematic literature review, for induction and maintenance of remission. Future trials are needed to investigate the efficacy of more recent and upcoming drug classes in patients with ulcerative proctitis. |
Pediatric Ulcerative Colitis Is A Fibrotic Disease And Linked With Chronicity Of Inflammation. Pediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlates with the presence, chronicity and degree of mucosal inflammation. Fibrosis should be recognized as a complication of pediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease. |
| J Neurogastroenterol Motil |
Individuals with constipation/GERD overlap tend to have worsened symptoms and quality of life. |
| Neurogastroenterol Motil |
The model rats of visceral hypersensitivity possess the decreased expression of occludin, ZO-1, AQP3, AQP8, and the increased expression of claudin-2 and claudin-4, meanwhile develop an imbalance of intestinal flora which probably increase serine protease activity, thereby activating the PAR2/ERK signaling and causing the intestinal barrier disorder. |
Diurnal changes of colonic motility and regulatory factors for colonic motility in Suncus murinus. These results indicate that the fundamental mechanisms of colonic motility in suncus are similar to those in humans and dogs, and we thus propose that suncus could serve as a novel small animal model for studying colonic motility. |
The addition of AAF to a FFED did not lead to a larger decrease in PEC between baseline and 6 weeks, but may result in a significant improvement of QoL in adult EoE patients NL6014 (NTR6778). |
Differential but not synergistic effects of WD and CRS were noted at the host-microbe interface suggesting multifactorial responses that require further investigation. |
High-resolution colonic manometry interobserver analysis trial. For the majority of motor patterns, the overall IOA for colonic manometry was substantial or high. This high level of agreement supports the use of colonic manometry application in clinical and research settings. Harmonization has the potential to improve agreement for long anterograde motor patterns with high amplitudes and for mixed direction patterns. |
The protective effect of STW 5 against RS-induced IBS is related to its ability to normalize the induced changes in 5-HT in the brain-gut axis and counteract the stress-induced oxidative stress and inflammation. |
FGID hospitalization prevalence rates decreased recently, possibly due to national healthcare policy implementation. Nonetheless, constipation admissions increased. LOS was stable in recent years but associated costs-per-hospitalization were increasing over time, probably due to endoscopic procedures. More studies are needed to explain these prevalence and cost trends. |
Reviews/Editorials
Plenty of the editorials have full text available through the publisher website using the provided link
| Aliment Pharmacol Ther |
| Gastroenterology |
| Gastrointest Endosc |
| Hepatology |
Sex hormones are responsible for multiple physiologic processes by signalling through estrogen (ER) and androgen receptors (AR).(1) ERs and ARs are expressed in liver and biliary tract cells in normal and diseased states in both men and women. Thus, the liver is recognized as a sex hormone responsive organ. In general, estrogen is associated with hepatic "protection" while androgens associate with hepatic "progression". |
| J Hepatol |
Alpha-1 antitrypsin deficiency: a re-surfacing adult liver disorder. We review genotype-related hepatic phenotypes/disease predispositions. We also describe the mechanisms and factors promoting the development of liver disease, as well as approaches to evaluate the extent of liver fibrosis. We discuss the emerging therapeutic approaches, diagnosis, and clinical management of this neglected disorder. |
Treatment for hepatocellular carcinoma (HCC) has experienced major advancements since the last update of the official Barcelona Clinic Liver Cancer (BCLC) prognosis and treatment strategy published in 2018. Advancements in the field have emerged in al areas, but in this manuscript, we present those that have primed a change in the strategy and comment why some encouraging data in select interventions are still considered immature and in need of further research to gain their incorporation into an evidence-based model for clinicians and researchers. Finally, we describe the critical insight and expert knowledge that is needed to take clinical decisions in individual patients so that the recommendation takes into account al the needed parameters to allow a personalised approach. |
Gut-derived systemic inflammation as a driver of depression in chronic liver disease. The underlying mechanisms explaining the critical relationship between depression and cirrhosis remain to be fully elucidated. Several other psychosocial and biological factors are likely to be involved, and therefore the cause is probably multifactorial. However, the role of the dysfunctional gut-liver-brain axis as a driver of gut-derived systemic inflammation requires further exploration and consideration as a target for therapy for depression in patients with cirrhosis. |
| Neurogastroenterol Motil |
Digital health for functional gastrointestinal disorders. In recent years, applications in digital health have created a new set of tools that can improve the care of these patients, including through improved symptom tracking, physiologic monitoring, direct provision of care, and patient support. Purpose The purpose of this review is to evaluate how digital applications are being used to manage functional gastrointestinal disorders today, with several examples of relevant technologies and organizations. It also the shortcomings of current treatment strategies and how they can be overcome. |
The biopsychosocial framework as it applies to FGID has led to the inclusion of both psychosocial assessments in clinical management and research protocols. Future directions include the development of symptom-specific questionnaires for groups of FGIDs, culturally specific psychosocial questionnaires, and inclusion of psychosocial well-being as primary or secondary outcomes in clinical research trials. In this review, we aim to explore the role of psychological questionnaires in clinical care and research trials and share practical tips on incorporating a biopsychosocial framework in the care of patients with FGIDs. |
Letters&Replies
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
Mungmunpuntipantip's observations on our recent paper (1). We totally agree that it is usually difficult to associate autoimmune hepatitis (AIH) like syndrome with a drug or vaccine administration. However, more and more cases of post-anti- severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) vaccination are being recorded (2-5). |
Letter to the Editor: HBcrAg and Prediction of Hepatocellular Carcinoma Risk. We wish to respond to the comments received from Drs. Wu, Tseng and Kao. Our analysis was focused on comparing HBV RNA and hepatitis B core related antigen (HBcrAg) levels with existing markers of hepatitis B virus (HBV) replication (HBV DNA and hepatitis B surface antigen) and whether the two novel markers could improve distinguishing the different phases of infection. |
Letter to the Editor: New kid in the playground: HBcrAg and risk of HCC. We read with great interest the article entitled "Comparison of Novel Biomarkers with Conventional HBV Markers among Untreated Adults with Chronic Hepatitis B in North America" by Ghany et al 1 Patients with chronic hepatitis B (CHB) are at risk of developing hepatocellular carcinoma (HCC) and serum markers reflecting viral replication could serve as HCC predictors. In addition to serum HBV DNA, hepatitis B core-related antigen (HBcrAg) and HBV RNA levels are two novel viral biomarkers correlated with levels of intrahepatic covalently closed circular DNA. 2,3 . |
With great interest, we read a study about a novel model modification for end-stage liver disease-sodium (MELD). (1) Starlinger P and colleagues concluded that the addition of C-reactive protein (CRP) and von Willebrand factor antigen (vWF-Ag) to the Model for End-Stage Liver Disease-Sodium (MELD-Na) improves the prediction of waitlist mortality. However, several crucial concerns attached our due attention. |
Lettter to the editor on "Autoimmune hepatitis after COVID-19 vaccination". mentioned for AIH cases and discuss on the possible association between AIH and COVID-19 vaccination [1]. Vaccine adverse effect is possible and liver problem flowing vaccination is an interesting clinical problem. Some researchers propose that abnormal immune response is the definitive cause of AIH [2]. |
Response to: HEP-21-1951 by Meng-Si Luo, Guan-Jiang Huang. We want to thank Luo MS and Huang GJ for their interest in our study. In their Letter to the Editor, they raise concerns about discrepancies in patient characteristics between included cohorts. |
| Inflamm Bowel Dis |
| J Hepatol |
Others
all remaining publications eg case reports, images of the month, etc…
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Endoscopy |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
| Inflamm Bowel Dis |
| J Crohns Colitis |
| J Hepatol |